Borenstein, J Bone Joint Surg Am 2001 - The Value of Magnetic Resonance Imaging of the Lumbar Spine to Predict Low-Back Pain in Asymptomatic Subjects: A Seven-Year Follow-Up Study - Article Summary

The Value of Magnetic Resonance Imaging of the Lumbar Spine to Predict Low-Back Pain in Asymptomatic Subjects: A Seven-Year Follow-Up Study

Borenstein, Wiesel, et al.·J Bone Joint Surg Am·2001·430 citations·Prospective cohort

Background

In 1989, a group of 67 asymptomatic individuals with no history of back pain underwent magnetic resonance imaging of the lumbar spine. 21 subjects (31%) had an identifiable abnormality of a disc or of the spinal canal. In the current study, we investigated whether the findings on the scans of the lumbar spine that had been made in 1989 predicted the development of low-back pain in these asymptomatic subjects.

Methods

A questionnaire concerning the development and duration of low-back pain over a 7-year period was sent to the 67 asymptomatic individuals from the 1989 study.
A total of 50 subjects completed and returned the questionnaire.
A repeat magnetic resonance scan was made for 31 of these subjects.
2 neuroradiologists and one orthopaedic spine surgeon interpreted the original and repeat scans in a blinded fashion, independent of clinical information.
At each disc level, any radiographic abnormality, including bulging or degeneration of the disc, was identified.
Radiographic progression was defined as increasing severity of an abnormality at a specific disc level or the involvement of additional levels.

Results

Of the 50 subjects who returned the questionnaire, 29 (58%) had no back pain.
Low-back pain developed in 21 subjects during the 7-year study period.
The 1989 scans of these subjects demonstrated normal findings in 12, a herniated disc in 5, stenosis in 3, and moderate disc degeneration in one.
8 individuals had radiating leg pain; 4 of them had had normal findings on the original scans, 2 had had spinal stenosis, one had had a disc protrusion, and one had had a disc extrusion.
In general, repeat magnetic resonance imaging scans revealed a greater frequency of disc herniation, bulging, degeneration, and spinal stenosis than did the original scans.

Conclusions

The findings on magnetic resonance scans were not predictive of the development or duration of low-back pain. Individuals with the longest duration of low-back pain did not have the greatest degree of anatomical abnormality on the original, 1989 scans. Clinical correlation is essential to determine the importance of abnormalities on magnetic resonance images.

Supplemental

The Value of Magnetic Resonance Imaging of the Lumbar Spine to Predict Low-Back Pain in Asymptomatic Subjects: A Seven-Year Follow-Up Study.

Borenstein, Wiesel, et al.J Bone Joint Surg Am2001430 citationsProspective cohort